Type Miscast: An Elmhurst Doctor's Type 2 Diabetes Misdiagnosis Results in the Death of a Six-Year-Old Girl

The little girl could barely breathe. She lay on the hospital bed, her chest rising with each forced inhalation. Irma Nicanor held her only child's hand. The six-year-old's eyes were closed, but Irma felt her tiny fingers squeezing.

Mercado was not board-certified in her specialty. She failed the American Board of Pediatrics certification exam more than five times.

"Stay strong, Claudialee," she told her in Spanish.

Irma was dazed by how everything had gone so bad so quickly. It was early on a January evening in 2010. They'd checked into New York Hospital in Flushing that afternoon. Claudialee was nauseated and had a tummy ache. Irma figured she'd caught a stomach virus from a boy in their apartment building. She now knew that it was more than that.

Ellen Weinstein

Courtesy Paul Hayt

Claudialee Gomez-Nicanor wanted to be a veterinarian when she grew up.

Two days before, Cladialee was running around the house, climbing over couches and crawling under tables. She seemed as healthy as she'd ever been. Yes, she was overweight, and her blood sugar was slightly high, but Irma was seeing to it that her daughter would get fit.

A bubbly girl with a loud laugh, full cheeks, and a thick mop of dark brown hair, Claudialee had plenty of energy for that mission. The girl took ballet and karate lessons. She ran around the park with her dad and rode bikes with her cousin. During snack time at P.S. 32, she pulled out sandwich bags filled with celery and carrots and sliced fruit. Her first-grade teacher would eat with Claudialee so that she wouldn't feel bad about not having sweets like the other kids.

Irma was always conscious about her daughter's health. Over the past three months alone, she'd taken Claudialee to six medical appointments: three times to her pediatrician, Dr. Thelma Cabatic, for flu shots and checkups; and three times to her endocrinologist, Dr. Arlene Mercado, to deal with her blood sugar. At each visit, Mercado would tell Irma that her girl was fine, in need of nothing more than diet and exercise.

Yet two weeks after her last checkup, here was Claudialee struggling for air, half-conscious in an emergency room. "Patient has slight movement of all four extremities spontaneously but not on command," the hospital notes read. "Mumbles occasionally."

The scene was overwhelming for a mother. Nurses scurrying around. Chemicals with smells much stronger than the cleaning supplies Irma used in her job as a housekeeper. Intravenous tubes attached to Claudialee's arms, alternately streaming potassium salts, water, and glucose. The girl's blood sugar had risen to 525 milligrams per deciliter—more than five times the normal level.

How could this happen? Irma kept asking herself.

Claudialee's lungs struggled as the night wore on. Nurses strapped an oxygen mask to her face. It wasn't enough. They decided to push a tube down the child's throat so a ventilator could help her breathe. But Claudialee wasn't having it. Even half-conscious, she was still a flare of vigor. Her arms flailed and her legs kicked. The nurses didn't expect such strength. They retreated and injected her with a sedative. Then they inserted the tube. Claudialee was now unconscious and dependent on a machine to supply her with oxygen.

Irma sat in the waiting room, praying. She called her sister Marta. It was about 4 a.m., but Marta rushed to the hospital. She got lost in the hallways, missed the waiting room, and ended up at Claudialee's bedside. The two were alone, the only sounds coming from the robotic hums and beeps of intensive care.

"It hurts," Marta thought she heard the girl whisper.

"Where does it hurt?"

There came no reply.

St. James Avenue was quiet and still on October 31, 2009. Irma and Claudialee passed the modest wood-frame homes with yards fronted by low chain-link or wrought-iron fences. American flags fluttered beside satellite dishes. Not a single person was in sight. Just the kind of tranquility a family hopes for when they move to Elmhurst.

Mother and daughter stopped in front of a cream-colored three-story house, then walked up the driveway to a concrete backyard. Irma might as well have been taking Claudialee to a classmate's birthday party.

Court documents, medical records, and interviews would detail what followed.

The pair descended a stairwell to a minimalist setup: a desk and several chairs. Curtains forming two makeshift rooms. Dr. Arlene Mercado's office was in the basement of her sister Myra Mercado Capistrano's house.

Mercado opened the clinic in 2007. Thirteen different insurance companies listed her practice in their network. She had a second practice at the SUNY Downstate Medical Center in Brooklyn. And she accepted Medicaid, the government health program for low-income people. She was a pediatric endocrinologist, specializing in children and the hormones and chemicals that could stunt growth or bring on early puberty. The most common issue she dealt with was diabetes.

She was well versed in practice, if not theory. Mercado was not board-certified in her specialty, American Board of Pediatrics records show. She failed the certification exam more than five times. Without passing that, she couldn't attempt the next step, the pediatric endocrinology test. But these setbacks didn't stop her. Board certification isn't mandatory. In fact, though she couldn't pass the test herself, Mercado taught a certification-exam review course in Children's Hospital at SUNY Downstate.

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I feel terrible after reading this. Mishaps occur often but
doctors should be more careful. This sort of misdiagnosis is not acceptable.
After all the research and treatments
found for diabetes, if someone dies because of misdiagnosis, it can be very
enraging.

Like rty9, I am a diabetic. I am seen for primary care in a federally supported community clinic of a major academic medical center, Montefiore, in the Bronx, where I live. Most of the patients, including myself, are low income, many on medicaid or uninsured. I have also been seen by a private endocrinologist. In both settings, everyone who is diabetic or pre-diabetic has a glucose finger stick test each time he/she comes in. It does not need to be done by a doctor, or sent to a lab. The whole thing takes a minute and results are available immediately. Even if this doctor was so out of it that she thought this lovely child had type II diabetes, if she had been doing this simple finger stick she would have known her glucose was through the roof. This negligence of the basics of endocrinology amounts to homicide. Why is she still on the faculty of SUNY??? This was truly tragic, and the fact that she continues in practice with the ability to kill another child is terrifying.

This gross negligence of Mercado and Cabatic was the direct cause of this child's death. There is NO EXCUSE for such a misdiagnosis. EVERY glucose meter on the market in the US--including the store-brand ones for $10 for the meter, and including the teeny one which is the cap for the vial of testing strips--is accurate enough to catch this! There was NO need to do a venous draw and wait 2 weeks for a lab turnaround; why did nether "doctor" have a fingerstick glucose meter there in the office, and why did neither tell the mom to go to a chain drugstore and get one? Or better, write the prescription for the meter and strips which IS COVERED by Medicaid in every state. Even Type 2 diabetes needs to be monitored daily! If the "doctor" was ordering lab tests, why did neither order a C-peptide measurement, which is THE definitive factor for Type 1 diabetes.

These two are not the only ignoramuses with medical licenses who endanger the lives of diabetic patients everyday. Earlier this year I was admitted to a small-city facility of the largest and oldest HMO in the country after going to the ER (I called the advice nurse first before going to the ER). The hospitalist was a DO (osteopath) who was too lazy to contact either my primary care provider (an MD) or diabetes care manager (an NP-CDE), or even look at the settings and history on my insulin pump! I had to call a family member to bring me my meter and insulin so I could take care of myself; I literally walked off the floor and out of the hospital and walked home when the hospital administration did not replace the ignorant DO with someone competent and accountable. I have also complained to the state boards, and to the regulating agency, but because I took my care into my own hands, and left the hospital before I was irreparably damaged, it was ruled that I had suffered no harm. Interesting that the HMO refunded my ER co-pay and did not bill me anything for the inpatient time!

I've been diabetic for nearly 50 years, so I have knowledge about diabetes that neither Claudialee nor her overwhelmed mother had. THEY were not the ones expected to be knowledgable about this condition. Instead, the persons who SHOULD have had at least the knowledge of adult Type 1 patients exhibited less expertise than the writers of popular magazine ads for diabetes testing supplies and accessories. Irma trusted these women with her daughter's life, and their willful neglect killed her child. I am so shocked and disgusted with these murderers and with the regulatory agencies which supposedly protect the public I cannot find adequate words

Dear Irma, I am so sorry for the loss of your precious little girl. I pray that her death was not in vain, and that this reporting to the public will result in action to prevent another such tragedy from happening to another family..

I am glad the mom won the case and the doctor admitted fault. At least she will not be putting more people at risk. When you see a doctor's office too dirty or messy, friends and family helping out, it means they are providing sub-standard care and uneducated. You need real nurses and trained medical personnel. Its best to question our doctors and look up things to make sure they are doing at least some of the right tests. Some of you may not realize Obamacare could set in motion sub-standard care like this. Be warned. National health care is good, but this Obamacare is too large and needs to be cut back and made voluntary.

Oh, and I hope someone checks all those other children she says she's diagnosed with type II diabetes. Some of them may also have type I diabetes, and they may be in danger, too. This woman sounds like her medical judgement is being clouded by her assumptions about weight.

This is just unconscionable. I'm not a fan of the overuse of lawsuits, but in this case, I hope the mom sues the hell out of that doctor. This is so incompetent that it borders on murder. That poor little girl. She had her whole life ahead of her.

@newlight51 Really? What mistaken assumptions are you basing that statement on? I've been living in Canada and the UK for the past ten years after living in the US for the first 33 years of my life, and the care is MORE, not less, professional than the care in the US. Doctors and insurance companies make less money, however.